Takotsubo cardiomyopathy

A 43-year-old woman mistakenly took venlafaxine 300 mg/day instead of 75 mg/day for a few days. She developed acute chest pain and dyspnea due to a takotsubo cardiomyopathy [SEDA-33, 313]. Venlafaxine was withdrawn and she recovered completely. 

Drug withdrawal Stress (takotsubo) cardiomyopathy occurred in a 44-year-old man in whom severe opioid withdrawal was precipitated 2 hours after administration of naltrexone for alcohol consumption [117 ]. He had a history of heroin use and was taking methadone 120mg/day. Stress cardiomyopathy was beheved to be the result of a marked increase in catecholamine plasma concentrations following abrupt opioid withdrawal. 

Cardiovascular Takotsubo cardiomyopathy [SEDA-33, 313] has been described after local application of adrenaline during nasal surgery in two cases cardiovascular MRI scans showed myocardial vasodilatation, capillary leak, and regional edema [1" ]. Reports linking takotsubo syndrome to the use of adrenaline during anaphylaxis have been reviewed... 

Inverted takotsubo cardiomyopathy, in which there is left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex, has been attributed to the inadvertent administration of intravenous adrenaline and noradrenaline [4 ]. 

In eight women with raised plasma adrenaline and noradrenaline concentrations secondary to various types of stress, takotsubo cardiomyopathy was associated with endothelial cell apoptosis [5 ]. 

The EIDOS and DoTS descriptions of takotsubo cardiomyopathy due to catecholamines are shown in Figure 1. 

Cardiovascular Takotsubo cardiomyopathy [SEDA-33, 313] has been attributed to high-dose dopamine in a 78-year-old woman who had acute coronary syndrome. Her blood pressure was low and the intraventricular pressure was high during dopamine infusion she improved when the dopamine was gradually withdrawn and carvedilol was added [60" ]. 

Uchida Y, Egami H, Uchida Y, Sakurai T, Kanai M, Shirai S, Nakagawa O, Oshima T. Possible participation of endothelial cell apoptosis of coronary microvessels in the genesis of takotsubo cardiomyopathy. Clin Cardiol 2010 33(6) 371-7. 

Mosley WJ 2nd, Manuchehry A, McEvoy C, Rigolin V. Takotsubo cardiomyopathy induced by dobutamine infusion a new phenomenon or an old disease with a new name. Echocardiography 2010 27(3) E30-3. 

Saito R, Takahashi T, Noshita N, Narisawa A, Negi K, Takei K, Kaneko U. Takotsubo cardiomyopathy induced by dobutamine infusion during hypertensive therapy for symptomatic vasospasm after subarachnoid hemorrhage—case report. Neurol Med Chir (Tokyo) 2010 50(5) 393-5. 

Abe Y, Tamura A, Kadota J. Prolonged cardiogenic shock caused by a high-dose intravenous administration of dopamine in a patient with takotsubo cardiomyopathy. Int J Cardiol 2010 141(1) el-3. 

Cardiovascular Takotsubo cardiomyopathy has been reported in an elderly woman who underwent pharmacological stress myocardial perfusion imaging with dipyridamole [55 ]. All abnormalities resolved completely 1 month after the initial stress test. 

Stress cardiomyopathy (takotsubo cardiomyopathy, broken heart syndrome , or gebrochenes Herz Syndrom ) was first described in Japan in the early 1990s [E] and has been reviewed [2 ]. Tako tsubo means octopus trap in Japanese. 

Extrinsic moiety Catecholamines Intrinsic moietyl Adrenoceptors Distribution Myocardium Outcome Takotsubo cardiomyopathy Sequela Takotsubo cardiomyopathy due to catecholamines... 

Indirect effects of drugs on catecholamines have ako resulted in takotsubo syndrome. In one case there was transient typical ballooning of the left ventricular apex during systole following the use of cocaine, thought to have been due to inhibition of catecholamine reuptake [22ft]. A 43-year-old woman who took an overdose of venlafaxine, an inhibitor of serotonin and noradrenaline reuptake, developed a takotsubo cardiomyopathy and there was an increase in urinary normetadrenaline (normetanephrine) concentration [23 ]. 

Cases of takotsubo cardiomyopathy reported after anaphylaxk [25=, 2, 27= J... 

Varieties There are three main types left ventricular apical ballooning (classical takotsubo cardiomyopathy), an inverted or reverse variant (basal akinesb with a hyperdynamic apex, abo called the artichoke heart ), and a midventricular variant. 

Reverse takotsubo cardiomyopathy has abo been attributed to adrenaline in a 24-year-old woman with no previous hbtory of cardiac dbease [44 ]. 

Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Sasaka K. Reversible left ventricular dysfunction takotsubo cardiomyopathy related to catecholamine cardiotoxicity. J Electrocardiol 2002 35... 

Takizawa M, Kobayakawa N, Uozumi H, Yonemura S, Kodama T, Fukusima K, Takeuchi H, Kaneko Y, Kaneko T, Fujita K, Honma Y, Aoyagi T. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int J Cardiol 2007 114(1) el5-7. 

Di Valentino M, Balestra GM, Christ M, Raineri I, Oerth D, ZeUweger MI. Inverted takotsubo cardiomyopathy due to pheochromoc)rtoma. Eur Heart J 2008 29(6) 830. 

Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med 2008 5(1) 22-9. 

Harle T, Kronberg K, Nef H, Mollmann H, Elsasser A. Inverted takotsubo cardiomyopathy following accidental intravenous administration of epinephrine in a young woman. Clin Res Cardiol 2011 100(5) 471-3. 

Saeki S, Matsuse H, Nakata H, Fukahori S, Miyahara Y, Kohno S. Case of bronchial asthma complicated with Takotsubo cardiomyopathy after frequent epinephrine medication. Nihon Kokyuki Gakkai Zasshi 2006 44(10) 701-5. 

Litvinov IV, Kotowycz MA, Wassmann S. Iatrogenic epinephrine-induced reverse Takotsubo cardiomyopathy direct evidence supporting the role of catecholamines in the pathophysiology of the broken heart syndrome Clin Res Cardiol 2009 98(7) 457-62. 

Brewington SD, Abbas AA, Dbton SR, Grines CL, O Neill WW. Reproducible microvascular dysfunction with dobuta-mine infusion in Takotsubo cardiomyopathy presenting with ST segment elevation. Catheter Cardiovasc Interv 2006 68(5) 769-74. 

Bruder O, Hunold P, Jochims M, Waltering KU, Sabin GV, Barkhausen J. Reversible late gadolinium enhancement in a case of Takotsubo cardiomyopathy following high-dose dobutamine stress MRI. Int J Cardiol 2008 127(1) e22-4. 

Silberbauer J, Hong P, Lloyd GW. Takotsubo cardiomyopathy (left ventricular... 

Cherian J, Kothari S, Angelis D, Atef A, Downey B, Kirkpatrick Jr. J. Atypical takotsubo cardiomyopathy dobutamine-precipitated apical ballooning with left ventricular outflow tract obstruction. Tex Heart Inst J 2008 35(1) 73-5. 

Drug withdrawal Transient left ventricular ballooning syndrome (takotsubo cardiomyopathy) occurs mostly in post-menopausal women in response to stressful events and beta-blockers are used to treat it. Abrupt withdrawal of beta-blockade can result in a hyperadrenergic syndrome that can lead to takotsubo cardiomyopathy, even in the absence of a stressful precipitating event [14 ]. 

A case of inverted takotsubo cardiomyopathy was reported in a 30-year-old woman with essential thrombocythemia who was exposed to anagrelide (2 mg/day) and phentermine [61 ]. 

Dziewierz A, Olszanecka A, Wilinski J, Rakowski T, Kleczynski P, Dubiel JS, et al. Inverted takotsubo cardiomyopathy in a patient with essential thrombocythemia exposed to anagrelide and phentermine. Int J Cardiol 2012 160(2) e31-2. 

Cardiovascular Cases of Takotsubo cardiomyopathy have been reported in recent literature. 

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